Art Therapy as an Intervention for Bereaved Adolescents Valerie Javier Department of Psychology, Counseling, and Art Therapy COUN 7550 Dec. 2024 Dr. Sheila Lorenzo de la Peña Introduction Problem to be Investigated • Research surrounding grief generally focuses on adult grief, not considering that adolescent grief differs (Alvis et al., 2023) Purpose Statement • Design a curriculum utilizing an art therapy and cognitive behavioral framework to support grieving adolescents Justification • Approximately 5.5 million children in the United States will lose a parent or sibling before the age of 18 (Hillis et al., 2021). • Numbers increase in times of catastrophe, such as pandemics and war (Burns et al., 2020). • Adolescents grieve in ways that is different from adults and children • Increased likelihood for unsafe coping mechanisms, such as substance use and self-harm (Andriessen et. al, 2018). Terms Related to the Study Adolescence Art therapy Bereavement Grief Loss Mourning Prolonged grief disorder Literature Review Adolescence • Significant development physically, cognitively, emotionally, and socially as a child transitions to adulthood • Puberty/hormones • Piaget’s Theory of Cognitive Development (Formal Operations) • Erik Erikson’s Stages of Psychosocial Development (Identity vs. Confusion) • Social pressures/increased responsibilities • Increased risk-taking behaviors Literature Review Grief • Associated with physiological distress, separation anxiety, confusion, yearning, dwelling on the past, and apprehension about the future (American Psychological Association, 2018) • In the US, many find discomfort talking about grief (Morley, 2023) • Mental & physical effects • crying, lack of energy, irregular sleep, and difficulty with concentration • emotions coincide with grief, which may include distress, shock, anxiety, guilt, anger, and a longing for the lost loved one • Disorientation, loss of sense of self (Morley, 2023) • A grieving brain enters fight, flight, or freeze mode (Paturel, 2020) • Grieving time and processes unique to each individual • Prolonged grief • Elisabeth Kubler-Ross’s Stages of Grief Literature Review Adolescents & Grief • Individual responses to loss are impacted by the youth’s cognitive development at the time of loss (Alvis et al., 2023) • The risk of long-term serious mental health concerns is 2.5 times greater in adolescents experiencing bereavement compared to non-bereaved adolescents (Burrell et al., 2022) • depression, posttraumatic stress, substance use, a decline in academics, and impairment in developmental tasks (Alvis et al., 2023). • Prolonged grief disorder higher risk of health issues & suicidality (Falk et al., 2022). • maladaptive behaviors, such as using substances to manage (Andriessen et. al, 2018). • Suppress emotions, struggle with verbal expression of emotions • No support in understanding their grief experience a greater intensity and duration of grief (Palmer et al., 2016). Literature Review Developmental Factors • impacted by the progression of developing skills such as self-regulation, identity formation, and the ability to cope (Palmer et al., 2016). • Identity formation/relation to peers • Movement towards autonomy • Increased impulsivity • Abstract thought • Developmentally appropriate strategies of support: • normalizing grief responses • building connections with others • counseling & creative therapies (Palmer et al., 2016), • social support Literature Review Grief Training in Mental Health Professional Training Programs • mental health professionals may not be adequately prepared to work with bereaved clients (Sawyer et al., 2022). • No CACREP standards • School counselors Literature Review Art Therapy as an Intervention for Grief • “Art therapy is a mental health profession that enriches the lives of individuals, families, and communities through active artmaking, creative process, applied psychological theory, and human experience within a psychotherapeutic relationship” (AATA, 2017) • Release of intense emotions related to loss & communicating nonverbal bereavement experiences (Bat-Or & Garti, 2019) • Conscious & unconscious elements • supports meaning making, crisis resolution, and emotional expression (Potash & Ho, 2014; Weiskittle & Gramling, 2018) Literature Review Group Art Therapy • connections with others can be a rich source of support, establish a sense of belonging, and increase resiliency (Robb, 2022) • Decrease loneliness • Normalizes grief & validates emotions • Safe space • the sense of belonging in group from witnessing one another (Moon, 2010) Cognitive Behavioral Art Therapy (CBAT) • modify maladaptive thoughts, increase coping skills, and reduce emotional stress (Rosal, 2018). • Construction of self • Tolerate ambiguity Methodology Target Audience • Adolescents (ages 12-18) in out of home placement • Hogan Inventory of Bereavement – Short Form (Children & Adolescents) Curricular Structure • CBAT • Closed group, 6-8 participants • 10 weeks • Master’s level art therapist Curricular Outline • Weekly 90-minute sessions • Warm up, main intervention, mindfulness-based wrap-up • Goals: • process intense emotions associated with grief, memorialize the deceased, meaning making, explore self-concept, sense of belonging and community Curriculum Week Intervention Goals 1 Introduction Introduction of group; Establishing group norms 2 Emotional Color Wheel Identification of emotions experienced related to grief; Fostering a sense of belonging within the group 3-4 Masquerade Ball Identification of emotions experienced related to grief; Exploring self-concept 5-7 Story Book Reflecting on events surrounding the loss; Reflecting on past, present, and future with the deceased; explore self-concept 8 Changes Collage Reflect on changes that have occurred since the loss; to identify coping skills; Reframe perspectives on change 9 Memory Box To honor the deceased by memorializing them; To contain experienced grief 10 Affirmation Bracelets Wrap up; Reflect on time in group; Closure Post Cards Goals • Reflect on grief journey thus far; Encourage self-expression towards loved one Suggested art materials • Blank postcards plus additional materials will vary week to week depending on main intervention Masquerade Ball Goals • Identifying emotions surrounding grief • Exploring self-concept & increase self-esteem Suggested Art Materials • Paper mache masks • Acrylic paint, brushes, water, palettes • Craft accessories such as feathers, rhinestones, scrap paper, and glue Changes Collage Goals • To reflect on changes that have occurred since the loss • To identify emotions regarding changes • To reframe perspectives on change • To identify coping skills Materials • Magazines/newspaper • Scrap book paper • Glue • Scissors • 11x14 cardstock Discussion Limitations • Cultural differences • Out of home placement • Personal struggles with grief Suggestions for Future Research • Grief across the lifespan • Length of time before intervention/prevent prolonged grief? 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